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Rocholl M, Wilke A, Meyer J, John SM, Ludewig M. Illness Perceptions of Patients with Occupational Skin Diseases in a Healthcare Centre for Tertiary Prevention: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5652. [PMID: 37174171 PMCID: PMC10178866 DOI: 10.3390/ijerph20095652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
Objectives: To investigate the illness perceptions of patients with occupational skin diseases (OSDs). Design: Cross-sectional study. Setting: Specialised healthcare centre for inpatient and outpatient individual prevention in occupational dermatology in Germany. Participants: A total of 248 patients with hand eczema (55.2% female; average age: 48.5 years, SD: 11.9) were included in the final analyses. Measures: A modified and recently validated version of the 'Revised Illness Perception Questionnaire' (IPQ-R) was used to assess illness perceptions. Severity of skin disease was evaluated with the Patient-Oriented Eczema Measure (POEM), the Osnabrueck Hand Eczema Severity Index (OHSI), and a single, self-reported global item. The Erlangen Atopy Score (EAS) was used for atopy screening. Results: We found strong illness identity, high emotional impact, and long timeline beliefs, meaning that study participants perceive their OSD on the hands as a highly symptomatic, emotionally burdening, and chronic condition. Results suggest that hand eczema has a major impact on how participants manage their own lives, particularly during everyday life and occupational activities. Study participants predominantly identified irritant or sensitising substances and activities at work as well as skin protection regimes as causes of their disease. Conclusions: Healthcare workers should consider the illness perceptions as well as the disease burden of patients with an OSD on the hands in clinical practice. Multi-professional approaches to patient care should be sought. Illness perception in (occupational) dermatological patients should be the subject of further research.
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Affiliation(s)
- Marc Rocholl
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
| | - Annika Wilke
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
| | - Julia Meyer
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
| | - Swen Malte John
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
| | - Michaela Ludewig
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
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Prevalence, risk factors, and prevention of occupational contact dermatitis among professional cleaners: a systematic review. Int Arch Occup Environ Health 2023; 96:345-354. [PMID: 36409350 DOI: 10.1007/s00420-022-01937-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence, risk factors, and prevention of occupational contact dermatitis (OCD), as well as risk factors and consequences of OCD among professional cleaners. METHODS A systematic review following PRISMA guidelines was performed using Medline, EMBASE, and Cochrane Library. RESULTS Thirty-nine studies containing over 109.000 participants were included in the review. The prevalence of OCD varied between 2.2% and 30.1%. Main occupational risk factors for developing OCD among cleaners included wet work and irritants in cleaning products (bleach, chlorine, ammonia, multi-use-cleaning) and skin contact to metal. The most common contact allergies included rubber, biocides, nickel/cobalt, and perfumes. Other risk factors were inconsistent use of protective gloves and low educational level. Consequences associated with OCD included significant impairment in quality of life, tendency to have unscheduled absence from work, sick leave, increased rate of disability, and recognized degree of injury. Only one prevention study has been published investigating the effect of an educative course in skin-protective behavior in cleaners. The study reported a higher degree of knowledge of skin protection, a decrease in the severity of hand eczema, and a shift toward fewer daily hand washings at follow-up after 3 months. CONCLUSION Our study proves that OCD is common in cleaners, and the main risk factors included wet work, irritants, and contact allergies, as well as inconsistent use of protective gloves and low educational level. More focus and a greater number of studies are needed on skin protection in this population.
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Heijkants CH, de Wind A, van Hooff MLM, Geurts SAE, Boot CRL. Effectiveness of Team and Organisational Level Workplace Interventions Aimed at Improving Sustainable Employability of Aged Care Staff: A Systematic Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:37-60. [PMID: 36149548 PMCID: PMC10025231 DOI: 10.1007/s10926-022-10064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 06/16/2023]
Abstract
Purpose The sustainable employability of healthcare professionals in aged care is under pressure, but research into the effectiveness of interventions aimed at improving employees' sustainable employability is scarce. This review therefore aimed to investigate the effectiveness of workplace interventions on sustainable employability of healthcare professionals in aged care. Methods A systematic literature search was performed. Studies were included when reporting about the effect of an intervention at work in an aged care setting on outcomes related to one of the three components of sustainable employability (i.e. workability, vitality, employability). The methodological quality of each study was assessed and a rating system was used to determine the level of evidence. Additionally, a sensitivity analysis was performed, accounting for the match between the intervention's focus and the targeted component of sustainable employability. Results Current review includes 32 interventions published between 1996 and 2019. Interventions covered learning and improving skills, changing the workplace, and exercising or resting. The initial analysis showed a strong level of evidence for employability and insufficient evidence for workability and vitality. The sensitivity analysis revealed strong evidence for the effectiveness of interventions addressing either employability or workability, and insufficient evidence for vitality. Conclusions Evidence for workplace interventions on sustainable employability of healthcare professionals in aged care differed. We found strong evidence for effects of workplace interventions on employability and for those directly targeting workability. Evidence for effects of interventions on vitality was insufficient. The alignment of the interventions to the targeted component of sustainable employability is important for effectiveness.
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Affiliation(s)
- Ceciel H Heijkants
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
- , Thomas van Aquinostraat 4, room 04.362, 6525GD, Nijmegen, The Netherlands.
| | - Astrid de Wind
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Sabine A E Geurts
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Cécile R L Boot
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands
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4
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Larese Filon F, Maculan P, Crivellaro MA, Mauro M. Effectiveness of a Skin Care Program With a Cream Containing Ceramide C and a Personalized Training for Secondary Prevention of Hand Contact Dermatitis. Dermatitis 2023; 34:127-134. [PMID: 36939821 PMCID: PMC10029085 DOI: 10.1089/derm.2022.29002.flf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Background/Objectives: The aim of our study was to investigate the effectiveness of personalized training on skin protection associated with the regular use of ceramide-containing cream (CC) versus other creams (OC) for improving hand contact dermatitis. Methods: We performed a double-center randomized trial that enrolled workers with hand dermatitis. All workers received personalized training. The intervention was 3 times per day application of the study emollient. The control arm used an emollient of choice without ceramide, as needed. The primary outcome was improvement in hand dermatitis at 1 and 3 months of follow-up. Results: In total, 102 patients with hand dermatitis were enrolled in this study. Improvement in dermatitis was found in 40%, 52.5%, 50%, and 63% of OC and CC, at the first and second follow-ups, respectively. The use of CC was significantly associated with an improvement in dermatitis (odds ratios 2.6; 95% confidence intervals 1.30-5.2), analyzed using generalized equation estimation during the follow-up. Conclusion: Our study demonstrated that an educational personalized intervention could improve the signs and symptoms in patients with hand dermatitis, and the use of a CC resulted in a significantly better outcome during the 3 months of follow-up.
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Affiliation(s)
| | - Pietro Maculan
- Unit of Occupational Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | | | - Marcella Mauro
- From the *Unit of Occupational Medicine, University of Trieste, Trieste, Italy
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5
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Heichel T, Sonsmann FK, John SM, Krambeck K, Maurer J, Nienhaus A, Nordheider K, Stasielowicz L, Wilke A, Brans R. Effects and acceptance of semipermeable gloves compared to cotton gloves in patients with hand dermatoses: Results of a controlled intervention study. Contact Dermatitis 2022; 87:176-184. [PMID: 35396860 DOI: 10.1111/cod.14123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/16/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Semipermeable gloves might be an alternative to cotton gloves in management of hand dermatoses. OBJECTIVES To compare acceptance and tolerability of gloves made of cotton or a semipermeable Sympatex membrane in patients with hand dermatoses and their effect on skin lesions when worn overnight. METHODS 199 patients with work-related symmetrical hand dermatoses were asked to wear a cotton glove (COT) on one hand and a Sympatex glove underneath a cotton glove (SYM/COT) on the other hand for nineteen consecutive nights. The severity of skin lesions was regularly examined. A questionnaire on acceptance and tolerability was used in a subset of 126 patients. RESULTS Data on skin lesions were available for 183 participating patients (92%). The severity did not differ substantially between hands covered with SYM/COT or COT over time. Questionnaire data were available for 120 patients (95%). SYM/COT received better ratings regarding climate conditions while COT showed superiority in wearing comfort, practicality and appearance. CONCLUSIONS Both SYM/COT and COT were well tolerated and accepted in patients with hand dermatoses. Hence, SYM/COT may serve as suitable alternative for COT as comfort gloves supporting therapeutic efforts. The observed slight differences may influence the decision when selecting the glove type. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Theres Heichel
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Flora K Sonsmann
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology at the University of Osnabrück, Osnabrück, Germany
| | - Swen M John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology at the University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), Hamburg, Germany
| | - Kathrin Krambeck
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), Hamburg, Germany
| | - Julia Maurer
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - Albert Nienhaus
- Competence Centre for Epidemiology and Health Service Research in Nursing, Institute for Health Service Research in Dermatology and Nursing, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kathrin Nordheider
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | | | - Annika Wilke
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology at the University of Osnabrück, Osnabrück, Germany
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology at the University of Osnabrück, Osnabrück, Germany
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6
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Coppeta L, De Zordo LM, Papa F, Pietroiusti A, Magrini A. Skin sensitization among night shift and daytime healthcare workers: a cross sectional study. Cent Eur J Public Health 2021; 29:191-194. [PMID: 34623118 DOI: 10.21101/cejph.a6260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/15/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Allergic contact dermatitis (ACD) in the healthcare sector is a major occupational health hazard. There are many reasons for a higher frequency of ACD in healthcare personnel compared to other populations: among others, simultaneous exposure to multiple substances, use of aggressive detergents and wet work. However, studies that systematically correlate skin symptoms with the presence of sensitization investigated through patch tests in specific categories of health workers are very rare and conflicting. Although some studies have reported a correlation between skin disease and night shift, the strength of the evidence is rather limited. The purpose of our study was to investigate by means of patch testing the skin sensitization (SS) to common allergens in the hospital setting in a group of healthcare workers (HCW) reporting symptoms related to dermatitis, according to their job activity and their shift status. METHODS 132 HCWs visiting a health surveillance centre were investigated by means of specific questionnaire for dermatitis, followed by patch test evaluation including 40 haptens of the SIDAPA 2016 series. RESULTS Skin sensitization was observed in 1/3 of the subjects investigated by patch tests. The nursing job was strongly associated with cutaneous reactivity after controlling for the confounding of gender, age and other factors. Shift work was related to the prevalence of SS. CONCLUSIONS In our study, the nurse's role and shift work were significantly associated with the risk of cutaneous sensitization, in particular for common antigens.
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Affiliation(s)
- Luca Coppeta
- Occupational Medicine Department, Tor Vergata University of Rome, Rome, Italy
| | | | - Francesca Papa
- Occupational Medicine Department, Tor Vergata University of Rome, Rome, Italy
| | - Antonio Pietroiusti
- Occupational Medicine Department, Tor Vergata University of Rome, Rome, Italy
| | - Andrea Magrini
- Occupational Medicine Department, Tor Vergata University of Rome, Rome, Italy
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7
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Heichel T, Brans R, John SM, Nienhaus A, Nordheider K, Wilke A, Sonsmann FK. Acceptance of semipermeable glove liners compared to cotton glove liners in health care workers with work-related skin diseases: Results of a quasi-randomized trial under real workplace conditions. Contact Dermatitis 2021; 85:543-553. [PMID: 34232510 DOI: 10.1111/cod.13929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/08/2021] [Accepted: 07/05/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Glove liners (GLs) made of cotton (COT) are worn under impermeable gloves to prevent occlusion effects. Semipermeable GLs made of Sympatex (SYM) might be an alternative. OBJECTIVES To evaluate the acceptance of GLs (COT/SYM) in health care workers (HCWs) with work-related skin diseases (WRSDs). METHODS One hundred sixty-one HCWs with WRSDs were asked to wear GLs in combination with occlusive gloves for 10 ±2 weeks under workplace conditions. A questionnaire was applied to compare acceptance and usability of the respective glove combinations and previously used protective gloves (PUGs). RESULTS A total of 120 data sets were available (SYM: n = 65, 77.4%; COT: n = 55, 71.4%). Both GLs provided a significantly lower sweating sensation, more pleasant climate, comfortable wearing experience, and moist or dry feeling on the skin compared to PUGs. SYM-GLs performed significantly better than COT-GLs regarding mobility of hands, sensitivity, and sense of touch. COT-GLs were significantly better than SYM-GLs in the categories fit, donning and doffing, and material contact. CONCLUSIONS Both GLs did not impair work performance, were applicable in various areas of health care activities, and were preferred over PUGs. Our results indicate that SYM-GLs are an alternative to COT-GLs and thus may contribute to current prevention strategies.
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Affiliation(s)
- Theres Heichel
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology, University of Osnabrück, Osnabrück, Germany
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology, University of Osnabrück, Osnabrück, Germany
| | - Albert Nienhaus
- Competence Centre for Epidemiology and Health Service Research in Nursing, Institute for Health Service Research in Dermatology and Nursing, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kathrin Nordheider
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Annika Wilke
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology, University of Osnabrück, Osnabrück, Germany
| | - Flora K Sonsmann
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology, University of Osnabrück, Osnabrück, Germany
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Gaskin S, Currie N, Cherrie JW. What Do Occupational Hygienists Really Know About Skin Exposure? Ann Work Expo Health 2021; 65:219-224. [PMID: 32537653 DOI: 10.1093/annweh/wxaa046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/31/2020] [Accepted: 04/21/2020] [Indexed: 11/13/2022] Open
Abstract
This article describes responses to a questionnaire on current work practices and understanding of the management of dermal exposure issues in the workplace from members of the British Occupational Hygiene Society (BOHS) and the Australian Institute of Occupational Hygienists (AIOH). The survey comprised questions in four key areas: employment demographics, experience managing dermal exposure, knowledge of dermal exposure management, and opinions on professional knowledge gaps and preferred training methods. The survey was disseminated in 2016 in the UK and 2018 in Australia, with 116 and 114 responses from each jurisdiction, respectively. The majority of respondents had personally evaluated the risks of dermal exposure to chemicals (BOHS 92%; AIOH 86%), albeit infrequently (less than a few times per year). Occupational Hygienists reportedly adopted a range of strategies to control dermal exposure problems, including chemical elimination/substitution (BOHS 68%; AIOH 68%), changing work practices (BOHS 79%; AIOH 75%), and education (BOHS 77%; AIOH 83%). The use of gloves or other personal protective equipment remained the most commonly cited exposure control measure (BOHS 99%; AIOH 97%). While there appeared to be a good understanding of common dermal exposure workplace scenarios (e.g. isocyanate exposure in motor vehicle repair, solvent exposure during spray painting), the overwhelming majority of respondents wished to find out more about assessing the risks from dermal exposure to chemicals (BOHS 89%; AIOH 88%). The outcomes suggest ways to increase the competence of professionals in dealing with dermal exposure matters in the workplace, through mechanisms such as web-based guidance, interactive educational materials and webinars, as well as workshops and seminars.
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Affiliation(s)
- Sharyn Gaskin
- Adelaide Exposure Science and Health, University of Adelaide, Thebarton, South Australia, Australia
| | - Naomi Currie
- Adelaide Exposure Science and Health, University of Adelaide, Thebarton, South Australia, Australia
| | - John W Cherrie
- Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot-Watt University, Riccarton, Edinburgh, UK.,Institute of Occupational Medicine, Research Avenue North, Edinburgh, UK
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9
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Madan I, Parsons V, Ntani G, Wright A, English J, Coggon D, McCrone P, Smedley J, Rushton L, Murphy C, Cookson B, Lavender T, Williams H. A behaviour change package to prevent hand dermatitis in nurses working in health care: the SCIN cluster RCT. Health Technol Assess 2020; 23:1-92. [PMID: 31635689 DOI: 10.3310/hta23580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although strategies have been developed to minimise the risk of occupational hand dermatitis in nurses, their clinical effectiveness and cost-effectiveness remain unclear. OBJECTIVES The Skin Care Intervention in Nurses trial tested the hypothesis that a behaviour change package intervention, coupled with provision of hand moisturisers, could reduce the point prevalence of hand dermatitis when compared with standard care among nurses working in the NHS. The secondary aim was to assess the impact of the intervention on participants' beliefs and behaviour regarding hand care, and the cost-effectiveness of the intervention in comparison with normal care. DESIGN Cluster randomised controlled trial. SETTING Thirty-five NHS hospital trusts/health boards/universities. PARTICIPANTS First-year student nurses with a history of atopic tendency, and full-time intensive care unit nurses. INTERVENTION Sites were randomly allocated to be 'intervention plus' or 'intervention light'. Participants at 'intervention plus' sites received access to a bespoke online behaviour change package intervention, coupled with personal supplies of moisturising cream (student nurses) and optimal availability of moisturising cream (intensive care unit nurses). Nurses at 'intervention light' sites received usual care, including a dermatitis prevention leaflet. MAIN OUTCOME MEASURE The difference between intervention plus and intervention light sites in the change of point prevalence of visible hand dermatitis was measured from images taken at baseline and at follow-up. RANDOMISATION Fourteen sites were randomised to the intervention plus arm, and 21 sites were randomised to the intervention light arm. BLINDING The participants, trial statistician, methodologist and the dermatologists interpreting the hand photographs were blinded to intervention assignment. NUMBERS ANALYSED An intention-to-treat analysis was conducted on data from 845 student nurses and 1111 intensive care unit nurses. RESULTS The intention-to-treat analysis showed no evidence that the risk of developing dermatitis was greater in the intervention light group than in the intervention plus group (student nurses: odds ratio 1.25, 95% confidence interval 0.59 to 2.69; intensive care unit nurses: odds ratio 1.41, 95% confidence interval 0.81 to 2.44). Both groups had high levels of baseline beliefs about the benefits of using hand moisturisers before, during and after work. The frequency of use of hand moisturisers before, during and after shifts was significantly higher in the intensive care unit nurses in the intervention plus arm at follow-up than in the comparator group nurses. For student nurses, the intervention plus group mean costs were £2 lower than those for the comparator and 0.00002 more quality-adjusted life-years were gained. For intensive care unit nurses, costs were £4 higher and 0.0016 fewer quality-adjusted life-years were gained. HARMS No adverse events were reported. LIMITATIONS Only 44.5% of participants in the intervention plus arm accessed the behaviour change package. CONCLUSION The intervention did not result in a statistically significant decrease in the prevalence of hand dermatitis in the intervention plus group. FUTURE WORK Participants had a high level of baseline beliefs about the importance of using hand moisturisers before, during and after work. Future research should focus on how workplace culture can be changed in order for that knowledge to be actioned. TRIAL REGISTRATION Current Controlled Trials ISRCTN53303171. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 58. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ira Madan
- Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Vaughan Parsons
- Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Georgia Ntani
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Alison Wright
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - John English
- Dermatology, Circle Nottingham NHS Treatment Centre, Nottingham, UK
| | - David Coggon
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Paul McCrone
- Centre for the Economics of Mental and Physical Health, King's College London, London, UK
| | - Julia Smedley
- Occupational Health Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lesley Rushton
- Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Caroline Murphy
- King's Clinical Trial Unit, King's College London, London, UK
| | - Barry Cookson
- Medical Microbiology, University College London, London, UK
| | - Tina Lavender
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Hywel Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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10
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Keefe AR, Demers PA, Neis B, Arrandale VH, Davies HW, Gao Z, Hedges K, Holness DL, Koehoorn M, Stock SR, Bornstein S. A scoping review to identify strategies that work to prevent four important occupational diseases. Am J Ind Med 2020; 63:490-516. [PMID: 32227359 DOI: 10.1002/ajim.23107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite being largely preventable, many occupational diseases continue to be highly prevalent and extremely costly. Effective strategies are required to reduce their human, economic, and social impacts. METHODS To better understand which approaches are most likely to lead to progress in preventing noise-related hearing loss, occupational contact dermatitis, occupational cancers, and occupational asthma, we undertook a scoping review and consulted with a number of key informants. RESULTS We examined a total of 404 articles and found that various types of interventions are reported to contribute to occupational disease prevention but each has its limitations and each is often insufficient on its own. Our principal findings included: legislation and regulations can be an effective means of primary prevention, but their impact depends on both the nature of the regulations and the degree of enforcement; measures across the hierarchy of controls can reduce the risk of some of these diseases and reduce exposures; monitoring, surveillance, and screening are effective prevention tools and for evaluating the impact of legislative/policy change; the effect of education and training is context-dependent and influenced by the manner of delivery; and, multifaceted interventions are often more effective than ones consisting of a single activity. CONCLUSIONS This scoping review identifies occupational disease prevention strategies worthy of further exploration by decisionmakers and stakeholders and of future systematic evaluation by researchers. It also identified important gaps, including a lack of studies of precarious workers and the need for more studies that rigorously evaluate the effectiveness of interventions.
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Affiliation(s)
- Anya R. Keefe
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
| | - Paul A. Demers
- Occupational Cancer Research Centre, Cancer Care Ontario Toronto Ontario Canada
| | - Barbara Neis
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
| | | | - Hugh W. Davies
- Occupational and Environmental Health, School of Population and Public HealthUniversity of British Columbia Vancouver British Columbia Canada
| | - Zhiwei Gao
- Department of Clinical Epidemiology, Faculty of MedicineMemorial University St. John's Newfoundland Canada
| | - Kevin Hedges
- Occupational Health Clinics for Ontario Workers Ottawa Ontario Canada
| | - D. Linn Holness
- Department of Medicine and Public Health SciencesSt. Michael's Hospital/University of Toronto, Toronto, Ontario, Canada
| | - Mieke Koehoorn
- Occupational and Environmental Health, School of Population and Public HealthUniversity of British Columbia Vancouver British Columbia Canada
| | - Susan R. Stock
- Division of Biological Risks and Occupational HealthInstitut national de santé publique du Québec (Quebec Institute of Public Health) Montreal Quebec Canada
- Department of Social and Preventive MedicineSchool of Public Health, Université de Montreal Montreal Quebec Canada
| | - Stephen Bornstein
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
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11
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Madan I, Parsons V, Ntani G, Coggon D, Wright A, English J, McCrone P, Smedley J, Rushton L, Murphy C, Cookson B, Williams HC. A behaviour change package to prevent hand dermatitis in nurses working in the National Health Service: results of a cluster randomized controlled trial. Br J Dermatol 2020; 183:462-470. [PMID: 31989580 PMCID: PMC7497001 DOI: 10.1111/bjd.18862] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Occupational hand dermatitis poses a serious risk for nurses. OBJECTIVES To evaluate the clinical and cost-effectiveness of a complex intervention in reducing the prevalence of hand dermatitis in nurses METHODS: This was a cluster randomized controlled trial conducted at 35 hospital trusts, health boards or universities in the UK. Participants were (i) first-year student nurses with a history of atopic conditions or (ii) intensive care unit (ICU) nurses. Participants at intervention sites received access to a behavioural change programme plus moisturizing creams. Participants at control sites received usual care. The primary outcome was the change of prevalent dermatitis at follow-up (adjusted for baseline dermatitis) in the intervention vs. the control group. Randomization was blinded to everyone bar the trials unit to ensure allocation concealment. The trial was registered on the ISRCTN registry: ISRCTN53303171. RESULTS Fourteen sites were allocated to the intervention arm and 21 to the control arm. In total 2040 (69·5%) nurses consented to participate and were included in the intention-to-treat analysis. The baseline questionnaire was completed by 1727 (84·7%) participants. Overall, 789 (91·6%) ICU nurses and 938 (84·0%) student nurses returned completed questionnaires. Of these, 994 (57·6%) had photographs taken at baseline and follow-up (12-15 months). When adjusted for baseline prevalence of dermatitis and follow-up interval, the odds ratios (95% confidence intervals) for hand dermatitis at follow-up in the intervention group relative to the controls were 0·72 (0·33-1·55) and 0·62 (0·35-1·10) for student and ICU nurses, respectively. No harms were reported. CONCLUSIONS There was insufficient evidence to conclude whether our intervention was effective in reducing hand dermatitis in our populations. Linked Comment: Brans. Br J Dermatol 2020; 183:411-412.
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Affiliation(s)
- I Madan
- Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - V Parsons
- Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - G Ntani
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, U.K
| | - D Coggon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, U.K
| | - A Wright
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, U.K
| | - J English
- Dermatology, Circle Nottingham NHS Treatment Centre, Nottingham, U.K
| | - P McCrone
- Centre for the Economics of Mental and Physical Health, King's College London, London, U.K
| | - J Smedley
- Occupational Health Service, University Hospital Southampton NHS Foundation Trust, Southampton, U.K
| | - L Rushton
- Epidemiology and Biostatistics, Imperial College London, London, U.K
| | - C Murphy
- King's Clinical Trial Unit, King's College London, London, U.K
| | - B Cookson
- Medical Microbiology, University College London, London, U.K
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
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12
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Papadatou Z, Williams H, Cooper K. Effectiveness of interventions for preventing occupational irritant hand dermatitis: a quantitative systematic review. ACTA ACUST UNITED AC 2019; 16:1398-1417. [PMID: 29894409 DOI: 10.11124/jbisrir-2017-003405] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of this review was to identify, appraise and synthesize the best available evidence on the effectiveness of moisturizers, barrier creams, protective gloves, skin protection education and complex interventions (a combination of two or more of the interventions listed here) in preventing occupational irritant hand dermatitis (OIHD) in wet workers, comparing each intervention to an alternative intervention or to usual care (workers' regular skin care regimen). INTRODUCTION The most significant occupational skin problem potentially encountered in wet work occupations is occupational dermatitis. When the skin comes into contact with hazardous substances at work, this can cause occupational dermatitis. Substances which may cause occupational dermatitis include cleaning products, organic solvents, metalworking fluids, cement, flour, adhesives, other chemicals and even certain plants. Occupational skin disease has adverse effects on quality of life and the long term prognosis for skin health is poor unless workplace exposures are addressed. To date, no systematic review has been undertaken to determine the effectiveness of interventions for the primary prevention of OIHD in wet workers. INCLUSION CRITERIA The review included any workers from healthcare (e.g. nurses, doctors and allied health professionals) and also people in different wet work occupations (e.g. hairdressers, florists, catering workers, metal workers) at similar risk of OIHD. Studies that assessed the following interventions in the primary prevention of OIHD in wet workers at the workplace and at home (before and after work) were included:Types of studies considered were experimental study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, and before and after studies. Primary outcome measures were OIHD incidence, and secondary outcome measures were product evaluation and change of occupation because of OIHD versus staying in the occupation. METHODS Published and unpublished literature in the English language was sought between 2004 and 2017. The databases searched included: COCHRANE CENTRAL, MEDLINE, CINAHL, AMED and Embase. The search for unpublished studies included: Google Scholar, Open DOAR and Robert Gordon University's thesis database, "OPEN AIR". RESULTS There were no studies located that met the inclusion requirements of this review. CONCLUSION There is currently no evidence available to determine the effectiveness of interventions to prevent OIHD amongst wet workers that met this review's inclusion criteria.
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Affiliation(s)
- Zoi Papadatou
- School of Health Sciences, Robert Gordon University, Aberdeen, Scotland
| | - Hector Williams
- School of Health Sciences, Robert Gordon University, Aberdeen, Scotland
| | - Kay Cooper
- The Scottish Centre for Evidence-based Multi-professional Practice: a Joanna Briggs Institute Centre of Excellence.,School of Health Sciences, Robert Gordon University, Aberdeen, Scotland
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13
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Abstract
Apart from endogenous factors, hand eczema is often caused by irritant or allergic contact dermatitis related to occupational or non-occupational exposure to skin hazards. This enables several complementary approaches on the level of primary, secondary and tertiary prevention. A high priority is set on identification and subsequent reduction or elimination of causative exposures. Important preventive approaches include legal regulations, technical and organizational measures as well as correct use of adequate personal protective equipment (e.g. protective gloves). Interventions based on health education are conducted to improve individual protective behaviour. Even though evidence-based proof of effectiveness is limited, preventive measures are considered of particular importance for avoidance of occupational hand eczema and its adverse sequelae. Therefore, a complex, step-wise approach to occupational skin diseases has been established in Germany. In recent years, the positive impact of secondary and tertiary preventive measures of this approach has been demonstrated.
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Affiliation(s)
- R Brans
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.
| | - C Skudlik
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland
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14
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Martos-Cabrera MB, Mota-Romero E, Martos-García R, Gómez-Urquiza JL, Suleiman-Martos N, Albendín-García L, Cañadas-De la Fuente GA. Hand Hygiene Teaching Strategies among Nursing Staff: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173039. [PMID: 31443355 PMCID: PMC6747325 DOI: 10.3390/ijerph16173039] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/17/2019] [Accepted: 08/18/2019] [Indexed: 12/23/2022]
Abstract
Background: Patient safety is a priority of any healthcare system, and one of the most effective measures is hand hygiene. For this, it is important that health staff have correct adherence and perform the technique properly. Otherwise, the incidence of nosocomial infections can increase, with consequent complications. The aim here was to analyze hand hygiene training and the effectiveness of different methods and educational strategies among nurses and whether they maintained correct adherence over time. Methods: A systematic review was conducted in the sources CINAHL (Cumulative Index to Nursing and Allied Health Literature), Dialnet, Lilacs (Latin American and Caribbean Health Sciences Literature), ProQuest (Proquest Health and Medical Complete), Medline, SciELO (Scientific Electronic Library Online), and Scopus. The search equation with Medical Subject Headings (MeSH) descriptors was “Nurs* AND (handwashing OR hand hygiene) AND clinical trial”. The review was performed following the recommendations of the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: n = 17 clinical trials were included, with a total of 5747 nurses and nursing students. Strategies such as reminder sounds, practical simulations, videos, and audiovisual media improved handwashing compliance. Adherence overtime increased by up to 60%. The greatest effectiveness was related to the use of povidone–iodine, which reduced colony formation compared Hand hygiene teaching strategies among nursing staff: a systematic review to soap. Conclusions: The strategies that go beyond teaching techniques such as lectures may be more effective at increasing hand hygiene compliance. Combined approaches to learning/instruction improve user satisfaction by enabling self-management, flexibility, and repetition.
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Affiliation(s)
| | | | - Raúl Martos-García
- Andalusian Health Service, Avenida del Sur N. 11, 18014 Granada, Spain
- Red Cross School of Nursing, University of Sevilla, Avenida la Cruz Roja N. 1, 41009 Sevilla, Spain
| | - José L Gómez-Urquiza
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración N. 60, 18016 Granada, Spain
| | - Nora Suleiman-Martos
- Faculty of Health Sciences, University of Granada, Calle Cortadura Del Valle S.N., 51001 Ceuta, Spain.
| | - Luis Albendín-García
- Andalusian Health Service, Avenida del Sur N. 11, 18014 Granada, Spain
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración N. 60, 18016 Granada, Spain
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15
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Gasparini G, Carmisciano L, Giberti I, Murgioni F, Parodi A, Gallo R. Healthy Hands: a pilot study for the prevention of chronic hand eczema in healthcare workers of an Italian University Hospital. GIORN ITAL DERMAT V 2019; 155:760-763. [PMID: 31195780 DOI: 10.23736/s0392-0488.19.06220-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Healthcare workers are at risk for occupational chronic hand eczema (CHE) because of frequent handwashing and prolonged use of occlusive gloves. Prevention programs based on skin care education have been shown to be beneficial. We developed and assessed the efficacy of a skin care educational intervention for healthcare workers of our hospital. METHODS The intervention consisted of two sessions, one week apart, each divided in a theoretical and a practical part, focusing on the skin barrier, types of eczema, risk factors for CHE, hand hygiene measures respectful of the skin, proper use of protective gloves and emollient creams. Its efficacy was assessed by a questionnaire, administered before and after the intervention, investigating the participants' knowledge of risk factors for CHE and risk behaviors. RESULTS Twenty-three subjects, mostly (65.2%) nurses, took part in the intervention; 60.9% had a self-reported atopic background and 65.2% participants reported a history of CHE. The intervention improved significantly the participants' knowledge on CHE risk factors, i.e. frequent handwashing (P=0.023), surgical scrubbing (P=0.016) and prolonged glove wearing (P=0.022). The frequency of hand washing was significantly reduced (P=0.022). The participants gave a positive unanimous feedback. CONCLUSIONS Our intervention was effective, by significantly improving the participants' knowledge and by inducing significant behavioral changes. Improving the formulation of alcoholic hand rubs may be a key factor to encourage their use. Coexisting nonoccupational risk behaviors are just as important in the prevention of CHE.
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Affiliation(s)
- Giulia Gasparini
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy - .,IRCCS San Martino University Hospital, Genoa, Italy -
| | - Luca Carmisciano
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Irene Giberti
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,IRCCS San Martino University Hospital, Genoa, Italy
| | - Rosella Gallo
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,IRCCS San Martino University Hospital, Genoa, Italy
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16
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Soltanipoor M, Kezic S, Sluiter JK, de Wit F, Bosma AL, van Asperen R, Rustemeyer T. Effectiveness of a skin care programme for the prevention of contact dermatitis in healthcare workers (the Healthy Hands Project): A single-centre, cluster randomized controlled trial. Contact Dermatitis 2019; 80:365-373. [PMID: 30652317 PMCID: PMC6593800 DOI: 10.1111/cod.13214] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/02/2018] [Accepted: 12/10/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Healthcare workers (HCWs) are at risk of developing hand dermatitis (HD). Guidelines recommend moisturizers to prevent HD, but in practice their effectiveness has been poorly investigated. OBJECTIVES To assess whether an intervention aimed at improving skin care leads to a reduction in HD severity. METHODS In this 1-year randomized controlled trial, 9 wards (285 HCWs) were allocated to an intervention group (IG), and 10 wards (216 HCWs) were allocated to the control group (CG). The intervention included provision of cream dispensers with electronic monitoring of use, regularly communicated to the HCWs. The primary and secondary outcomes were change from baseline in Hand Eczema Severity Index (HECSI) score (ΔHECSI) and change in natural moisturizing factor (NMF) level (ΔNMF). RESULTS At 12 months, the rates of loss to follow-up were 41% and 39% in the IG and the CG, respectively. The HECSI score was reduced in the IG by -6.2 points (95%CI: -7.7 to -4.7) and in the CG by -4.2 points (95%CI: -6.0 to -2.4). There was no significant difference in ΔHECSI or ΔNMF between the groups. Relative improvement in the HECSI score was significantly higher in the IG than in the CG (56% vs 44%). In a subgroup of HCWs with mild HD, the IG showed a larger HECSI score decrease than the CG (P < 0.001). CONCLUSION Although there was no significant effect on the primary outcomes, the intervention showed overall positive effects on the HECSI score.
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Affiliation(s)
- Maryam Soltanipoor
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam UMC (De Boelelaan), Amsterdam, The Netherlands
| | - Sanja Kezic
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith K Sluiter
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Fleur de Wit
- Department of Dermatology, Amsterdam UMC (De Boelelaan), Amsterdam, The Netherlands
| | - Angela L Bosma
- Department of Dermatology, Amsterdam UMC (Meibergdreef), Amsterdam, The Netherlands
| | - Ruth van Asperen
- Department of Dermatology, Amsterdam UMC (De Boelelaan), Amsterdam, The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology, Amsterdam UMC (De Boelelaan), Amsterdam, The Netherlands
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17
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Wilke A, Gediga G, Goergens A, Hansen A, Hübner A, John SM, Nordheider K, Rocholl M, Weddeling S, Wulfhorst B, Nashan D. Interdisciplinary and multiprofessional outpatient secondary individual prevention of work-related skin diseases in the metalworking industry: 1-year follow-up of a patient cohort. BMC DERMATOLOGY 2018; 18:12. [PMID: 30541516 PMCID: PMC6292163 DOI: 10.1186/s12895-018-0080-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 11/30/2018] [Indexed: 11/10/2022]
Abstract
Background In Germany, work-related skin diseases are predominant within the spectrum of reported occupational diseases. Metal workers are among the high-risk professions. Offering effective prevention programs to affected patients is of utmost importance to avoid deterioration of the disease and job loss. We conducted a 1-year follow-up in patients who participated in a multidisciplinary, complex outpatient prevention program representing a standard procedure of patient care by the respective statutory accident insurance. Methods The multi-component prevention program consists of multiprofessional individual patient counseling, a structured skin protection seminar in a group, as well as workplace visits and on-site counseling in terms of appropriate skin protection (e.g. gloves). An observational study with a 1-year follow-up and four measurements (T1-T4, longitudinal pre/post-test design) including dermatological examinations and standardized written questionnaires was conducted between 2013 and 2016 to assess changes over time regarding job loss and disease severity. Results Data from 94 patients (87 male, mean age: 45.4 years) were included in the analysis. One year after the skin protection seminar (T4), 83 patients (88.3%) remained in their original professional metalworking activity and four patients (4.3%) had given up their profession because of their skin disease. At baseline (T1), irritant contact dermatitis of the hands was the most frequent diagnosis (80.7%). Methods for self-reported disease severity showed good correlation with the clinical gold standard at T1 and T2 (dermatological examination with the Osnabrück Hand Eczema Severity Index / OHSI), and a significant decrease of the self-reported disease severity was found over time from T1 to T4 (p < 0.001). Further results indicate an improved self-perceived disease control and an overall satisfaction with the prevention program. Conclusions The results of this observational study demonstrate that the comprehensive prevention program positively influences the course of work-related skin diseases, increases the possibility to continue working in a “high-risk” profession and improves the disease management of metal workers. In the long term, the prevention program may lead to cost savings by preventing high therapy costs or professional retraining. Electronic supplementary material The online version of this article (10.1186/s12895-018-0080-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annika Wilke
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany. .,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany.
| | - Günther Gediga
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Andreas Goergens
- German Social Accident Insurance Institution for the woodworking and metalworking industries, district administration in Dortmund, Semerteichstraße 98, 44263, Dortmund, Germany
| | - Andreas Hansen
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Anja Hübner
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Swen Malte John
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Kathrin Nordheider
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Marc Rocholl
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Sabine Weddeling
- Department of Dermatology, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Germany
| | - Britta Wulfhorst
- Faculty of Human Sciences/Department of Educational Sciences, MSH Medical School Hamburg, University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany
| | - Dorothée Nashan
- Department of Dermatology, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Germany
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18
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Wilke A, Brans R, Nordheider K, Braumann A, Hübner A, Sonsmann FK, John SM, Wulfhorst B. Skin Protection Seminars to Prevent Occupational Skin Diseases: Results of a Prospective Longitudinal Study in Apprentices of High-risk Professions. Saf Health Work 2018; 9:398-407. [PMID: 30559987 PMCID: PMC6284163 DOI: 10.1016/j.shaw.2018.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 02/16/2018] [Accepted: 05/12/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Occupational skin diseases (OSDs) are frequent in professions with exposure to skin hazards. Thus, a health educational intervention for apprentices of high-risk professions was conducted. It was the aim of this study to gain insight into possible effects of this intervention. METHODS A one-time skin protection seminar was conducted in 140 apprentices of health-related and non-health-related professions [trained cohort (TC)]. In addition, 134 apprentices of the same occupations were monitored [untrained cohort (UTC)]. The OSD-specific knowledge and the skin condition of the hands were assessed at baseline (T0), after the seminar (T1), and after 6 (T2) and 12 months (T3). RESULTS The OSD-specific knowledge increased in all cohorts from T0 to T3, but we found a significantly higher knowledge in the TC at T2 (p < 0.001, t = 3.6, df = 196, 95% confidence interval = 0.9, 3.3) and T3 (p < 0.001, t = 3.8, df = 196, 95% confidence interval = 1.0, 3.2) compared to the UTC. Our results indicated a better skin condition of the hands in the TC of the health-related professions but not in the non-health-related professions. CONCLUSION The study indicates that an educational intervention may positively influence the disease-specific knowledge and the prevalence of OSD in apprentices. However, definite conclusions cannot be drawn because of the heterogeneous study cohorts and the study design. Future research should aim at tailoring primary prevention to specific target groups, e.g., in view of the duration and frequency of skin protection education, different professions, and gender-specific prevention approaches.
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Affiliation(s)
- Annika Wilke
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Richard Brans
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Kathrin Nordheider
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Antje Braumann
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Hamburg, Germany
| | - Anja Hübner
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Flora K. Sonsmann
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Swen M. John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Britta Wulfhorst
- Faculty of Human Sciences/Department of Educational Sciences, MSH Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
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Soltanipoor M, Kezic S, Sluiter J, Holman R. Statistical analysis plan for the Healthy Hands Project; single centre cluster-randomised clinical trial of a skin care program for the prevention of contact dermatitis in health care workers. Trials 2018; 19:421. [PMID: 30081929 PMCID: PMC6080425 DOI: 10.1186/s13063-018-2703-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Healthy Hands Project (HHP) is a randomised clinical trial aiming to determine the effectiveness of an intervention program in the prevention of hand dermatitis in healthcare workers (HCWs). The intervention is comprised of placing dispensers with hand creams on wards combined with continuous electronic monitoring of cream consumption and regular feedback to HCWs. The clinical severity (HECSI score) was used as the primary outcome and natural moisturising factor (NMF) levels as the secondary outcome. The study protocol for the cluster-randomised controlled trial of HHP was published in Trials in 2017. This article describes the detailed statistical analysis plan for the HHP trial. METHODS/DESIGN The HHP is a single-centre, cluster-randomised controlled trial with two parallel groups and blinded outcome assessment. This update article presents (1) the descriptive statistics of the primary and secondary outcomes, (2) the statistical models used for the analysis of the main outcomes, (3) sensitivity analyses on the effect of observed exposure to wet work, (4) handling of missing data including sensitivity analysis and (5) an updated power calculation. This statistical analysis plan was written prior to unblinding of the study. DISCUSSION This paper presents a comprehensive statistical analysis plan for the data resulting from the HHP trial. It supports transparency in reporting by clarifying differences between the previously published protocol and the proposed actual statistical analyses. TRIAL REGISTRATION Netherlands Trial Register (NTR), identification number NTR5564 . Registered on 2 November 2015.
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Affiliation(s)
- Maryam Soltanipoor
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Sanja Kezic
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Judith Sluiter
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Rebecca Holman
- Clinical Research Unit, Academic Medical Centre, PO Box 22660, 1100, DD, Amsterdam, The Netherlands
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Hamnerius N, Svedman C, Bergendorff O, Björk J, Bruze M, Pontén A. Wet work exposure and hand eczema among healthcare workers: a cross-sectional study. Br J Dermatol 2017; 178:452-461. [DOI: 10.1111/bjd.15813] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 01/20/2023]
Affiliation(s)
- N. Hamnerius
- Department of Occupational and Environmental Dermatology; Lund University; Skåne University Hospital; Malmö Sweden
| | - C. Svedman
- Department of Occupational and Environmental Dermatology; Lund University; Skåne University Hospital; Malmö Sweden
| | - O. Bergendorff
- Department of Occupational and Environmental Dermatology; Lund University; Skåne University Hospital; Malmö Sweden
| | - J. Björk
- Department of Occupational and Environmental Medicine; Lund University; Lund Sweden
- Clinical Studies Sweden; Forum South; Skåne University Hospital; Lund Sweden
| | - M. Bruze
- Department of Occupational and Environmental Dermatology; Lund University; Skåne University Hospital; Malmö Sweden
| | - A. Pontén
- Department of Occupational and Environmental Dermatology; Lund University; Skåne University Hospital; Malmö Sweden
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Gupta T, Arrandale VH, Kudla I, Holness DL. Gaps in Workplace Education For Prevention of Occupational Skin Disease. Ann Work Expo Health 2017; 62:243-247. [DOI: 10.1093/annweh/wxx093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 11/21/2017] [Indexed: 11/14/2022] Open
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Zack B, Arrandale VH, Holness DL. Preventing Occupational Skin Disease: A Review of Training Programs. Dermatitis 2017; 28:169-182. [DOI: 10.1097/der.0000000000000278] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Visan FA, Zakaria A, Castro J, Alhasanat O, Ismail KA, Ansari NA, Hamed M. SWITCH: Al Wakra Hospital Journey to 90% Hand Hygiene Practice Compliance, 2011 - 2015. BMJ QUALITY IMPROVEMENT REPORTS 2017; 6:u211699.w4824. [PMID: 28469905 PMCID: PMC5411721 DOI: 10.1136/bmjquality.u211699.w4824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Hand Hygiene is the cheapest and simplest way to prevent the spread of infection, however international compliance is below than 40% (WHO, 2009). In the experience of Al Wakra Hospital, the improvement in hand hygiene compliance highlighted not just interventions towards training and education but also behavioral motivation and physical allocations of hand hygiene appliances and equipment. Through motivating the behavioral, emotional, physical and intellectual dimensions of the different healthcare worker professions, hand hygiene compliance has increased from 60.78% in 2011 to 94.14% by the end of December 2015. It took 25 months of continuous and collaborative work with different healthcare workers to reach the 90% hand hygiene target. "Together, we have reached our goals and together we fight against infections! Because we always strive for excellence in everything we do - that is our vision here in Al Wakra Hospital."
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Affiliation(s)
| | | | | | | | | | | | - Manal Hamed
- Al Wakra Hospital, Hamad Medical Corporation, Qatar
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Soltanipoor M, Kezic S, Sluiter JK, Rustemeyer T. The effectiveness of a skin care program for the prevention of contact dermatitis in health care workers (the Healthy Hands Project): study protocol for a cluster randomized controlled trial. Trials 2017; 18:92. [PMID: 28245835 PMCID: PMC5331718 DOI: 10.1186/s13063-017-1803-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/18/2017] [Indexed: 11/16/2022] Open
Abstract
Background Health care workers (HCW) are at high risk for developing occupational hand dermatitis (HD) due to frequent exposure to ‘wet work’. Amongst HCWs, nurses are at highest risk, with an estimated point prevalence of HD ranging between 12 and 30%. The burden of disease is high with chronicity, sick leave, risk of unemployment and impaired quality of life. Despite evidence from the medical literature on the risk factors and the importance of skin care in the prevention of HD, in practice, compliance to skin care protocols are below 30%. New preventive strategies are obviously needed. Methods/design This is a cluster randomized controlled trial, focusing on nurses performing wet work. In total, 20 wards are recruited to include 504 participating nurses in the study at baseline. The wards will be randomized to an intervention or a control group and followed up for 18 months. The intervention consists of the facilitation of creams being available at the wards combined with the continuous electronic monitoring of their consumption with regular feedback on skin care performance in teams of HCWs. Both the intervention and the control group receive basic education on skin protection (as ‘care as usual’). Every 6 months, participants of both groups will fill in the questionnaires regarding exposure to wet work and skin protective behavior. Furthermore, skin condition will be assessed and samples of the stratum corneum collected. The effect of the intervention will be measured by comparing the change in Hand Eczema Severity Index (HECSI score) from baseline to 12 months. The Natural Moisturizing Factor (NMF) levels, measured in the stratum corneum as an early biomarker of skin barrier damage, and the total consumption of creams per ward will be assessed as a secondary outcome. Discussion This trial will assess the clinical effectiveness of an intervention program to prevent hand dermatitis among health care workers Trial registration Netherlands Trial Register (NTR), identification number NTR5564. Registered on 2 November 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1803-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maryam Soltanipoor
- Department of Dermatology, VU University Medical Centre (VUmc), De Boelelaan 1117, Amsterdam, 1081HV, The Netherlands. .,Coronel Institute of Occupational Health, Academic Medical Center (AMC), Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
| | - Sanja Kezic
- Coronel Institute of Occupational Health, Academic Medical Center (AMC), Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Judith K Sluiter
- Coronel Institute of Occupational Health, Academic Medical Center (AMC), Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology, VU University Medical Centre (VUmc), De Boelelaan 1117, Amsterdam, 1081HV, The Netherlands
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Papadatou Z, Cooper K, Klein S, MacDuff C, Steiner M. Effectiveness of interventions for preventing occupational irritant hand dermatitis. ACTA ACUST UNITED AC 2016; 14:72-81. [DOI: 10.11124/jbisrir-2016-003159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Mauro M, De Giusti V, Bovenzi M, Larese Filon F. Effectiveness of a secondary prevention protocol for occupational contact dermatitis. J Eur Acad Dermatol Venereol 2016; 31:656-663. [DOI: 10.1111/jdv.13947] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/18/2016] [Indexed: 01/20/2023]
Affiliation(s)
- M. Mauro
- Clinical Unit of Occupational Medicine; Department of Medical Sciences; University of Trieste; Trieste Italy
| | - V. De Giusti
- Clinical Unit of Occupational Medicine; Department of Medical Sciences; University of Trieste; Trieste Italy
| | - M. Bovenzi
- Clinical Unit of Occupational Medicine; Department of Medical Sciences; University of Trieste; Trieste Italy
| | - F. Larese Filon
- Clinical Unit of Occupational Medicine; Department of Medical Sciences; University of Trieste; Trieste Italy
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Schubert S, Bauer A, Molin S, Skudlik C, Geier J. Occupational contact sensitization in female geriatric nurses: Data of the Information Network of Departments of Dermatology (IVDK) 2005-2014. J Eur Acad Dermatol Venereol 2016; 31:469-476. [PMID: 27518760 DOI: 10.1111/jdv.13915] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/08/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Geriatric nurses (GN) have a high risk of occupational contact dermatitis (OCD), with chronic irritant contact dermatitis predominating. However, allergic contact dermatitis is an important issue as well. Little is known whether the relevant occupational allergen spectrum reported in the 1990s, including fragrances, preservatives, rubber chemicals and ingredients of surface disinfectants to be the most common sensitizers in GN, is still valid. OBJECTIVES To monitor the current allergen spectrum in GN with OCD and verify the validity of the patch test recommendations (baseline-, preservative-, ointment base-, rubber-, disinfectant, series and fragrances) in GN with suspected OCD given by the German Contact Dermatitis Research Group (DKG). METHODS Retrospective analysis of IVDK data (2005-2014) of 743 female GN with OCD, in comparison to 695 GN without OCD. RESULTS GN with OCD reacted significantly more frequently to both fragrance mixes, hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC), thiuram mix, zinc diethyldithiocarbamate and mercaptobenzothiazole than GN without OCD. Reactions to MDBGN, methylchloroisothiazolinone/methylisothiazolinone and oil of turpentine occurred substantially, but not significantly more frequently among GN with OCD. The latter may be due to former use of a special alcoholic liniment in geriatric care. Among material from the patients' workplaces, tetrazepam was a frequent allergen, due to dust exposure from pill crushing. Furthermore, occupationally used protective gloves, body care products as well as surface disinfectants were often tested positively. CONCLUSIONS The general allergen spectrum in GN with OCD is unchanged, so the DKG patch test recommendations are still valid. Prevention of occupational sensitization should focus on fragrance-free hygiene and body care products, usage of accelerator-free protective gloves and avoidance of drug dust exposure.
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Affiliation(s)
- S Schubert
- Information Network of Departments of Dermatology, University of Göttingen, Göttingen, Germany
| | - A Bauer
- Department of Dermatology, University of Dresden, Dresden, Germany
| | - S Molin
- Department of Dermatology and Allergy, Ludwig-Maximilians-University München, Munich, Germany
| | - C Skudlik
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - J Geier
- Information Network of Departments of Dermatology, University of Göttingen, Göttingen, Germany
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Hines J, Wilkinson SM, John SM, Diepgen TL, English J, Rustemeyer T, Wassilew S, Kezic S, Maibach HI. The three moments of skin cream application: an evidence-based proposal for use of skin creams in the prevention of irritant contact dermatitis in the workplace. J Eur Acad Dermatol Venereol 2016; 31:53-64. [PMID: 27545662 PMCID: PMC5434821 DOI: 10.1111/jdv.13851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
Abstract
Contact dermatitis is one of the most common occupational diseases, with serious impact on quality of life, lost days at work and a condition that may be chronically relapsing. Regular prophylactic skin cream application is widely acknowledged to be an effective prevention strategy against occupational contact dermatitis; however, compliance rates remain low. To present a simple programme for skin cream application in the workplace with focus on implementation to drive down the rate of occupational irritant contact dermatitis, an expert panel of eight international dermatologists combined personal experience with extensive literature review. The recommendations are based on clinical experience as supported by evidence-based data from interventional studies. The authors identified three moments for skin cream application in the work place: (i) before starting a work period; (ii) after washing hands; and (iii) after work. Affecting behaviour change requires systematic communications, monitoring and reporting, which is proposed through Kotter's principles of organizational change management. Measurement tools are provided in the appendix. Interventional data based on application of this proposal is required to demonstrate its effectiveness.
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Affiliation(s)
- J Hines
- Deb Group Ltd., Research & Development, Denby, Derbyshire, UK
| | | | - S M John
- Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, Osnabrueck, Germany
| | - T L Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J English
- Nottingham NHS Treatment Center, Nottingham, UK
| | - T Rustemeyer
- Department of Dermatology and Allergology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - S Wassilew
- Hautarztzentrum Krefeld, Krefeld, Germany
| | - S Kezic
- Coronel Institute of Occupational Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - H I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. Infect Control Hosp Epidemiol 2016; 35 Suppl 2:S155-78. [DOI: 10.1017/s0899823x00193900] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Madan I, Parsons V, Cookson B, English J, Lavender T, McCrone P, Murphy C, Ntani G, Rushton L, Smedley J, Williams H, Wright A, Coggon D. A behavioural change package to prevent hand dermatitis in nurses working in the national health service (the SCIN trial): study protocol for a cluster randomised controlled trial. Trials 2016; 17:145. [PMID: 26987818 PMCID: PMC4797222 DOI: 10.1186/s13063-016-1255-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 02/17/2016] [Indexed: 11/25/2022] Open
Abstract
Background Hand dermatitis can be a serious health problem in healthcare workers. While a range of skin care strategies and policy directives have been developed in recent years to minimise the risk, their effectiveness and cost-effectiveness remain unclear. Evidence now suggests that psychological theory can facilitate behaviour change with respect to improved hand care practices. Therefore, we will test the hypothesis that a behavioural change intervention to improve hand care, based on the Theory of Planned Behaviour and implementation intentions, coupled with provision of hand moisturisers, can produce a clinically useful reduction in the occurrence of hand dermatitis, when compared to standard care, among nurses working in the UK National Health Service (NHS) who are particularly at risk. Secondary aims will be to assess impacts on participants’ beliefs and behaviour regarding hand care. In addition, we will assess the cost-effectiveness of the intervention in comparison with normal care. Methods/Design We will conduct a cluster randomised controlled trial at 35 NHS hospital trusts/health boards/universities, focussing on student nurses with a previous history of atopic disease or hand eczema and on nurses in intensive care units. Nurses at ‘intervention-light’ sites will be managed according to what would currently be regarded as best practice, with provision of an advice leaflet about optimal hand care to prevent hand dermatitis and encouragement to contact their occupational health (OH) department early if hand dermatitis occurs. Nurses at ‘intervention-plus’ sites will additionally receive a behavioural change programme (BCP) with on-going active reinforcement of its messages, and enhanced provision of moisturising cream. The impact of the interventions will be compared using information collected by questionnaires and through standardised photographs of the hands and wrists, collected at baseline and after 12 months follow-up. In addition, we will assemble relevant economic data for an analysis of costs and benefits, and collect information from various sources to evaluate processes. Statistical analysis will be by multi-level regression modelling to allow for clustering by site, and will compare the prevalence of outcome measures at follow-up after adjustment for values at baseline. The principal outcome measure will be the prevalence of visible hand dermatitis as assessed by the study dermatologists. In addition, several secondary outcome measures will be assessed. Discussion This trial will assess the clinical and cost effectiveness of an intervention to prevent hand dermatitis in nurses in the United Kigdom. Trial registration ISRCTN53303171: date of registration, 21 June 2013.
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Affiliation(s)
- Ira Madan
- Guy's and St Thomas' NHS Foundation Trust, Occupational Health Service, St Thomas' Hospital, Westminster Bridge Rd, London, SE1 7EH, UK.
| | | | | | - John English
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | | | | | | | - Julia Smedley
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Schönrock S, Schablon A, Nienhaus A, Peters C. What do healthcare workers in elderly care know about occupational health and safety? An explorative survey. J Occup Med Toxicol 2015; 10:36. [PMID: 26413137 PMCID: PMC4583745 DOI: 10.1186/s12995-015-0079-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Demographic changes will lead to a growing demand for healthy, motivated healthcare workers (HCW) in the years ahead. Along with well-targeted prevention, knowledge of occupational health and safety and infection precaution is essential for a healthy working life. In this context back-friendly working methods and protection from infectious diseases are necessary in elderly care. METHODS In 2012, a survey was conducted in nine residential and two semi-residential nursing homes, as well as in one home care service in the Schwerin area of northeast Germany. Four hundred and seventy three HCWs were asked to fill in a questionnaire on what they knew about aspects of occupational health and safety such as vaccinations and preventative measures administered by occupational physicians, hygiene, back-friendly working methods and infection prevention. The statistical evaluation was descriptive, with a comparison between job title. Differences were examined with chi square or Fisher's exact test. RESULTS The response rate was 28 % (n = 132). The largest group of respondents (36 %) were qualified geriatric HCWs. More than 74 % of employees felt well informed about opportunities for precautionary checks and vaccination by occupational physician, and 93 % utilized these opportunities. When it came to assigning modes of transmission to specific infectious diseases, only 23 % of participants were well informed, and one in three (31 %) care assistants was inadequately informed. Fewer than half of participants could correctly name the indications for hand disinfection. Only 66 % of the HCWs said they were aware of training offers for the management of multidrug-resistant organisms in their institution. They did know about possible aids to back-friendly working, although gaps in knowledge were apparent. Only 59 % of respondents knew that care utensils should preferably be stored at working height so as to reduce awkward body postures. CONCLUSIONS Employees in elderly care are well informed about the range of precautionary occupational medical examinations and take advantage of this offering. Questions in the survey regarding hygiene management were answered in a competent manner. On the other hand some gaps in the knowledge about infection prevention and occupational safety became apparent. Differences between qualified and unqualified participating professionals occurred only in the knowledge of infectious diseases and pathogens and the associated path of infection. The extent to which training can help to improve infection prevention and occupational health and safety should be investigated.
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Affiliation(s)
- Stefanie Schönrock
- University Medical Center Hamburg-Eppendorf (UKE), Institute for Health Services Research in Dermatology and Nursing (CVcare), Martinistrasse 52, 20246 Hamburg, Germany
| | - Anja Schablon
- University Medical Center Hamburg-Eppendorf (UKE), Institute for Health Services Research in Dermatology and Nursing (CVcare), Martinistrasse 52, 20246 Hamburg, Germany
| | - Albert Nienhaus
- University Medical Center Hamburg-Eppendorf (UKE), Institute for Health Services Research in Dermatology and Nursing (CVcare), Martinistrasse 52, 20246 Hamburg, Germany ; Department of Occupational Health Research, Institute for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
| | - Claudia Peters
- University Medical Center Hamburg-Eppendorf (UKE), Institute for Health Services Research in Dermatology and Nursing (CVcare), Martinistrasse 52, 20246 Hamburg, Germany
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Stocks SJ, McNamee R, Turner S, Carder M, Agius RM. The impact of national-level interventions to improve hygiene on the incidence of irritant contact dermatitis in healthcare workers: changes in incidence from 1996 to 2012 and interrupted times series analysis. Br J Dermatol 2015; 173:165-71. [PMID: 25652874 DOI: 10.1111/bjd.13719] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reducing healthcare-associated infections (HCAI) has been a priority in the U.K. over recent decades and this has been reflected in interventions focusing on improving hygiene procedures. OBJECTIVES To evaluate whether these interventions coincided with an increased incidence of work-related irritant contact dermatitis (ICD) attributed to hand hygiene or/and other hygiene measures in healthcare workers (HCWs). METHODS A quasi-experimental (interrupted time series) design was used to compare trends in incidence of ICD in HCWs attributed to hygiene before and after interventions to reduce HCAI with trends in the same periods in control groups (ICD in other workers). Cases of ICD reported to a U.K. surveillance scheme from 1996 to 2012 were analysed. The time periods compared were defined objectively based on the dates of the publication of national evidence-based guidelines, the U.K. Health Act 2006 and the Cleanyourhands campaign. RESULTS The reported incidence of ICD in HCWs attributed to hygiene has increased steadily from 1996 to 2012 [annual incidence rate ratio (95% confidence interval): hand hygiene only 1.10 (1.07-1.12); all hygiene 1.05 (1.03-1.07)], whereas the incidence in other workers is declining. An increase in incidence of ICD in HCWs attributed to hand hygiene was observed at the beginning of the Cleanyourhands campaign. CONCLUSIONS The increasing incidence of ICD in HCWs combined with the popularity of interventions to reduce HCAI warrants increased efforts towards identifying products and implementing practices posing the least risk of ICD.
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Affiliation(s)
- S J Stocks
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, University of Manchester, Manchester, M13 9PL, U.K.,Centre for Primary Care, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, U.K
| | - R McNamee
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, M13 9PL, U.K
| | - S Turner
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, University of Manchester, Manchester, M13 9PL, U.K
| | - M Carder
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, University of Manchester, Manchester, M13 9PL, U.K
| | - R M Agius
- Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, University of Manchester, Manchester, M13 9PL, U.K
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Ellingson K, Haas JP, Aiello AE, Kusek L, Maragakis LL, Olmsted RN, Perencevich E, Polgreen PM, Schweizer ML, Trexler P, VanAmringe M, Yokoe DS. Strategies to prevent healthcare-associated infections through hand hygiene. Infect Control Hosp Epidemiol 2015; 35:937-60. [PMID: 25026608 DOI: 10.1086/677145] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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van der Meer EWC, van der Gulden JWJ, van Dongen D, Boot CRL, Anema JR. Barriers and facilitators in the implementation of recommendations for hand eczema prevention among healthcare workers. Contact Dermatitis 2015; 72:325-36. [PMID: 25739424 PMCID: PMC5024051 DOI: 10.1111/cod.12331] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/04/2014] [Accepted: 11/16/2014] [Indexed: 11/28/2022]
Abstract
Background Evidence‐based recommendations are available for the prevention of hand eczema among healthcare workers. However, the implementation of these recommendations is not always successful. Objectives To identify barriers and facilitators in the implementation of recommendations for the prevention of hand eczema among healthcare workers alongside a randomized controlled trial. Methods A qualitative study was performed in which 19 healthcare workers were interviewed. The interview transcripts were open coded and also coded by means of a template by two researchers to identify relevant barriers and facilitators. Results Most barriers and facilitators reported for the recommendations were found at the level of the innovation (e.g. the recommendations), whereas for the guideline as a whole, multiple levels (socio‐political, organization, user, and facilities) were identified. Conclusions To enhance the implementation of recommendations for the prevention of hand eczema in a healthcare setting, having knowledge about these recommendations seems to be an important first step. In addition, maintaining the attention of the subject, testing the products beforehand and close collaboration with the infection control department might enhance implementation. Furthermore, it is important that the recommendations fit in with the work of the healthcare workers. When the implementation of the recommendations is prepared, these points should be taken into account.
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Affiliation(s)
- Esther W C van der Meer
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, van der Boechorststraat 7, 1007MB, Amsterdam, The Netherlands
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Ellingson K, Haas JP, Aiello AE, Kusek L, Maragakis LL, Olmsted RN, Perencevich E, Polgreen PM, Schweizer ML, Trexler P, VanAmringe M, Yokoe DS. Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. Infect Control Hosp Epidemiol 2015. [DOI: 10.1086/651677] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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van der Meer EWC, Boot CRL, van der Gulden JWJ, Knol DL, Jungbauer FHW, Coenraads PJ, Anema JR. Hands4U: the effects of a multifaceted implementation strategy on hand eczema prevalence in a healthcare setting. Results of a randomized controlled trial. Contact Dermatitis 2014; 72:312-24. [DOI: 10.1111/cod.12313] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/18/2014] [Accepted: 09/23/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Esther W. C. van der Meer
- Department of Public and Occupational Health EMGO Institute for Health and Care Research, VU University Medical Centre van der Boechorststraat 7 1081 BT Amsterdam The Netherlands
| | - Cécile R. L. Boot
- Department of Public and Occupational Health EMGO Institute for Health and Care Research, VU University Medical Centre van der Boechorststraat 7 1081 BT Amsterdam The Netherlands
- Body©Work, Research Centre Physical Activity, Work and Health, TNO‐VU University Medical Centre van der Boechorststraat 7 1081 BT Amsterdam The Netherlands
| | - Joost W. J. van der Gulden
- Department of Primary and Community Care Centre for Family Medicine, Geriatric care and Public Health, Radboud University Nijmegen Medical Centre PO Box 9101 6500 HB Nijmegen The Netherlands
| | - Dirk L. Knol
- Department of Epidemiology and Biostatistics EMGO Institute for Health and Care Research, VU University Medical Centre De Boelelaan 1118 1081 HZ Amsterdam The Netherlands
| | - Frank H. W. Jungbauer
- Department of Occupational Health University Medical Centre Groningen, University of Groningen Hanzeplein 1 9713GZ, Groningen The Netherlands
| | - Pieter Jan Coenraads
- Dermatology Department University Medical Centre Groningen, University of Groningen Hanzeplein 1 9713GZ, Groningen The Netherlands
| | - Johannes R. Anema
- Department of Public and Occupational Health EMGO Institute for Health and Care Research, VU University Medical Centre van der Boechorststraat 7 1081 BT Amsterdam The Netherlands
- Body©Work, Research Centre Physical Activity, Work and Health, TNO‐VU University Medical Centre van der Boechorststraat 7 1081 BT Amsterdam The Netherlands
- Research Centre for Insurance Medicine AMC‐UWV‐VU University Medical Centre van der Boechorststraat 7 1081 BT Amsterdam The Netherlands
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Clemmensen KKB, Randbøll I, Ryborg MF, Ebbehøj NE, Agner T. Evidence-based training as primary prevention of hand eczema in a population of hospital cleaning workers. Contact Dermatitis 2014; 72:47-54. [DOI: 10.1111/cod.12304] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 08/09/2014] [Accepted: 08/13/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Kim K. B. Clemmensen
- Department of Dermatology; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
| | - Ingelise Randbøll
- Department of Dermatology; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
| | - Malene F. Ryborg
- Department of Dermatology; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
| | - Niels E. Ebbehøj
- Department of Occupational and Environmental Medicine; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
| | - Tove Agner
- Department of Dermatology; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
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Fisker MH, Agner T, Lindschou J, Bonde JP, Ibler KS, Gluud C, Winkel P, Ebbehøj NE. Protocol for a randomised trial on the effect of group education on skin-protective behaviour versus treatment as usual among individuals with newly notified occupational hand eczema - the Prevention of Hand Eczema (PREVEX) Trial. BMC DERMATOLOGY 2013; 13:16. [PMID: 24245553 PMCID: PMC4225615 DOI: 10.1186/1471-5945-13-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/13/2013] [Indexed: 11/29/2022]
Abstract
Background The incidence of occupational hand eczema is approximately 0.32 per 1,000 person years. The burden of the disease is high, as almost 60% has eczema-related sick leave during the first year after notification, and 15% are excluded from the workforce 12 years after disease onset. New treatments and prevention strategies are needed. Methods/Design Trial design: The PREVEX trial is a randomised, parallel-group, superiority trial. Participants: All individuals from the Capital Region of Denmark and Region Zealand with a suspected occupational skin disorder notified to the National Board of Industrial Injuries between June 2012 and December 2013 are invited to participate in the trial. Inclusion criteria are: self-reported hand eczema and informed consent. Exclusion criteria are: age <18 years or >65 years; permanent exclusion from the workforce; inability to understand the Danish language; any serious medical condition; and lack of written informed consent. We plan to randomise 742 participants. Interventions: The experimental intervention is an educational course in skin-protective behaviour and written information about skin care related to the participants' specific occupation. Also, a telephone hotline is available and a subgroup will be offered a work-place visit. The experimental and the control group have access to usual care and treatment. All participants are contacted every eighth week with questions regarding number of days with sick leave or other absence from work. 12 months after randomisation follow-up is completed. Objective: To assesses the effect of an educational course versus treatment as usual in participants with newly notified occupational hand eczema. Randomisation: Participants are centrally randomised according to a computer-generated allocation sequence with a varying block size concealed to investigators. Blinding: It is not possible to blind the participants and investigators, however, data obtained from registers, data entry, statistical analyses, and drawing of conclusions will be blinded. Outcomes: The three co-primary outcomes, assessed at 12 months, are: total number of self-reported days with sick leave; health-related quality of life; and subjective assessment of hand eczema severity. Explorative outcomes are: self-reported eczema-related sick leave, absence from work registered by the DREAM-register and by self-report, risk behaviour, knowledge of skin protection and performance management (self-efficacy; and self-evaluated ability to self-care). Discussion The PREVEX trial will be the first individually randomised trial to investigate the benefits and harms of group-based education in patients with newly notified occupational hand eczema. Trial registration ClinicalTrials.gov Identifier: NCT01899287
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Affiliation(s)
- Maja Hvid Fisker
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark.
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Lee SW, Cheong SH, Byun JY, Choi YW, Choi HY. Occupational hand eczema among nursing staffs in Korea: Self-reported hand eczema and contact sensitization of hospital nursing staffs. J Dermatol 2013; 40:182-7. [PMID: 23294332 DOI: 10.1111/1346-8138.12036] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/05/2012] [Indexed: 11/28/2022]
Abstract
Occupational hand eczema is frequent in hospital workers, especially in nurses. A comprehensive understanding regarding hand eczema is essential for establishing proper prevention and treatment strategies. The purpose of this study was to identify the risk factors for hand eczema in hospital nursing staffs. A self-administered questionnaire study was performed on hospital nursing staffs at a single general hospital in Korea. In addition, 70 patients with hand eczema underwent patch testing. Five hundred and twenty-five of 700 invited nurses completed the study (response rate, 75.0%). The overall frequency of symptom-based hand eczema was 75.6%, and self-reported hand eczema was 31.0%. Risk factors for hand eczema were young age, history of atopic dermatitis, frequent hand washing (>20 times/day) and long duration of glove wearing (>5 min). Hand eczema was less frequent among frequent hand moisturizer users (>3-4 times/day). Positive patch test reactions were observed in 61.4%. Frequent allergens were nickel sulfate (35.7%), cobalt chloride (28.6%) and thiomersal (21.4%). Among various antibiotics, ciprofloxacin (11.4%), trimethoprim/sulfamethoxazole (11.4%) and gentamicin (7.1%) were revealed as common allergens, in order of frequency. Hand eczema is quite common among hospital nursing staffs. Proper preventive programs and educations are demanded.
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Affiliation(s)
- Sang W Lee
- Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, Korea
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Ibler KS, Jemec GBE, Diepgen TL, Gluud C, Lindschou Hansen J, Winkel P, Thomsen SF, Agner T. Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial. BMJ 2012; 345:e7822. [PMID: 23236031 PMCID: PMC3520547 DOI: 10.1136/bmj.e7822] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand eczema. DESIGN Randomised, observer blinded parallel group superiority clinical trial. SETTING Three hospitals in Denmark. PARTICIPANTS 255 healthcare workers with self reported hand eczema within the past year randomised centrally and stratified by profession, severity of eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group. INTERVENTIONS Education in skin care and individual counselling based on patch and prick testing and assessment of work and domestic related exposures. The control was treatment as usual. MAIN OUTCOME MEASURES The primary outcome was clinical severity of disease at five month follow-up measured by scores on the hand eczema severity index. The secondary outcomes were scores on the dermatology life quality index, self evaluated severity of hand eczema, skin protective behaviours, and knowledge of hand eczema from onset to follow-up. RESULTS Follow-up data were available for 247 of 255 participants (97%). At follow-up, the mean score on the hand eczema severity index was significantly lower (improved) in the intervention group than control group: difference of means, unadjusted -3.56 (95% confidence interval -4.92 to -2.14); adjusted -3.47 (-4.80 to -2.14), both P<0.001 for difference. The mean score on the dermatology life quality index was also significantly lower (improved) in the intervention group at follow-up: difference of means: unadjusted -0.78, non-parametric test P=0.003; adjusted -0.92, -1.48 to -0.37). Self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves were also statistically significantly better in the intervention group, whereas this was not the case for knowledge of hand eczema. CONCLUSION A secondary prevention programme for hand eczema improved severity and quality of life and had a positive effect on self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves. TRIAL REGISTRATION ClinicalTrials.gov NCT01012453.
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Affiliation(s)
- Kristina Sophie Ibler
- Department of Dermatology, Roskilde Hospital, Health Science Faculty, Køgevej 7-13, 4000 Roskilde, Denmark.
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Holness DL, Kudla I. Workers with occupational contact dermatitis: workplace characteristics and prevention practices. Occup Med (Lond) 2012; 62:455-7. [PMID: 22837331 DOI: 10.1093/occmed/kqs115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND There are many gaps in knowledge related to prevention practices in place for workers who subsequently develop occupational contact dermatitis (OCD). AIMS To describe the workplace characteristics and the prevention practices in workplaces where workers developed hand dermatitis. METHODS Consecutive cases of probable OCD were enrolled from a specialist occupational health clinic. At the time of the initial assessment, questionnaires were administered to collect information about clinical presentation, workplace characteristics and prevention practices at work. RESULTS 100 workers with hand dermatitis were enrolled in the study and 78 were considered to have OCD. Two-thirds of these had had some occupational health and safety or Workplace Hazardous Materials Information System (WHMIS) training in their workplace, however, training related to glove use and skin care was less common. Unionized workers were more likely to have received training. Workers involved in wet work were less likely to report training. CONCLUSIONS These findings suggest that there are gaps in prevention programs for work-related skin disease. Research is needed on effective strategies that are sustainable in the workplace.
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Affiliation(s)
- D L Holness
- Department of Occupational and Environmental Health, St. Michael's Hospital Toronto, Ontario, Canada.
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Mollerup A, Veien NK, Johansen JD. Chronic hand eczema--self-management and prognosis: a study protocol for a randomised clinical trial. BMC DERMATOLOGY 2012; 12:6. [PMID: 22691871 PMCID: PMC3492110 DOI: 10.1186/1471-5945-12-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/14/2012] [Indexed: 02/08/2023]
Abstract
Background Hand eczema has a one-year prevalence of approximately 10 % in the general Danish population. Often the disease becomes chronic with numerous implications for the individual’s daily life, occupation and quality of life. However, no guidelines of self-management recommendations beyond the acute stage are given. Self-management of the disease is pivotal and involves self-monitoring of the condition, medication adherence, and preventive behaviour. Interventions best to support the individual in this ongoing process need to be developed. Methods/design This paper describes the design of a randomised clinical trial to test a newly developed intervention of individual counselling versus conventional information. 300 patients consecutively referred to dermatologic treatment at two different settings are individually randomised to either the intervention programme, named ‘The Healthy Skin Clinic’ or to the control group. Block-wise randomisation according to setting and gender is carried out. The intervention offers a tool for self-monitoring; basic and specific individual counselling; the possibility of asynchronous communication with the intervention team; and an electronic patient dialogue forum. Primary outcome variable is objective assessment of the hand eczema severity performed at baseline prior to randomisation, and repeated at six months follow-up. Secondary outcome variables are dermatology related life quality and perceived global burden of disease. Discussion The trial aims at evaluating a newly developed guidance programme which is expected to support self-management of patients referred to dermatology treatment due to chronic hand eczema. The design of the protocol is pragmatic with blinding of neither participants nor the investigator. Thus, in the interpretation of the results, the investigator takes into account effects that may be attributed to actors of the interventions rather than the intervention per se as well of potential observer bias. Inclusion criterions are wide in order to increase transferability of the results. Trial registration The trial is registered in ClinicalTrials.Gov with registration number NCT01482663.
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Affiliation(s)
- Annette Mollerup
- National Allergy Research Centre, Copenhagen University Hospital Gentofte, Gentofte, Denmark.
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van Gils RF, Boot CR, van Gils PF, Bruynzeel D, Coenraads PJ, van Mechelen W, Riphagen II, Anema JR. Effectiveness of prevention programmes for hand dermatitis: a systematic review of the literature. Contact Dermatitis 2011; 64:63-72. [DOI: 10.1111/j.1600-0536.2010.01825.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Lan CCE, Tu HP, Lee CH, Wu CS, Ko YC, Yu HS, Lu YW, Li WC, Chen GS. Hand dermatitis among university hospital nursing staff with or without atopic eczema: assessment of risk factors. Contact Dermatitis 2010; 64:73-9. [DOI: 10.1111/j.1600-0536.2010.01813.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ibler KS, Agner T, Hansen JL, Gluud C. The Hand Eczema Trial (HET): Design of a randomised clinical trial of the effect of classification and individual counselling versus no intervention among health-care workers with hand eczema. BMC DERMATOLOGY 2010; 10:8. [PMID: 20807407 PMCID: PMC2939593 DOI: 10.1186/1471-5945-10-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 08/31/2010] [Indexed: 11/10/2022]
Abstract
Background Hand eczema is the most frequently recognized occupational disease in Denmark with an incidence of approximately 0.32 per 1000 person-years. Consequences of hand eczema include chronic severe eczema, prolonged sick leave, unemployment, and impaired quality of life. New preventive strategies are needed to reduce occupational hand eczema. Methods/Design We describe the design of a randomised clinical trial to investigate the effects of classification of hand eczema plus individual counselling versus no intervention. The trial includes health-care workers with hand eczema identified from a self-administered questionnaire delivered to 3181 health-care workers in three Danish hospitals. The questionnaire identifies the prevalence of hand eczema, knowledge of skin-protection, and exposures that can lead to hand eczema. At entry, all participants are assessed regarding: disease severity (Hand Eczema Severity Index); self-evaluated disease severity; number of eruptions; quality of life; skin protective behaviour, and knowledge of skin protection. The patients are centrally randomised to intervention versus no intervention 1:1 stratified for hospital, profession, and severity score. The experimental group undergoes patch and prick testing; classification of the hand eczema; demonstration of hand washing and appliance of emollients; individual counselling, and a skin-care programme. The control group receives no intervention. All participants are reassessed after six months. The primary outcome is observer-blinded assessment of disease severity and the secondary outcomes are unblinded assessments of disease severity; number of eruptions; knowledge of skin protection; skin-protective behaviour, and quality of life. Trial registration The trial is registered in ClinicalTrials.Gov, NCT01012453.
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